Patient visits to emergency departments spike in California and across the U.S.According to new data released by California’s Office of Statewide Health Planning and Development, emergency department visits by Medi-Cal beneficiaries spiked by approximately 50 percent between 2013 and 2014. The report shows that nearly 800,000 Medi-Cal beneficiaries visited emergency departments statewide during the first quarter of 2013. That number jumped to around 1.16 million by the end of the fourth quarter of 2014.

Experts suggest the increase is related to California’s expansion of Medi-Cal, which is the state’s Medicaid program. Under the Affordable Care Act, enrollment in the program jumped from 8.6 million in late 2013 to around 11.3 million at the end of 2014.

“There is a direct correlation with the expansion of Medi-Cal in 2013 and 2014,” said Anthony Wright, executive director of Health Access. “This is what you’d expect.”

Emergency departments seeing increased volume nationwide

The situation mirrors what is reportedly occurring across the country. On May 4, the American College of Emergency Room Physicians released a survey showing that 28 percent of 2,099 physicians polled observed significant volume increases in the months since the Affordable Care Act took effect. Another 47 percent of doctors observed slight volume increases. By comparison, less than half of doctors noticed increases in 2013.

The numbers contradict one of the selling points of the health care reform law, which was intended to decrease emergency department visits as more people gained access to primary care doctors and preventative health care.

According to experts, one of the primary causes of increased emergency department visits is primary care doctors who refuse to accept Medicaid due to its low reimbursement rates. This exacerbates the country’s already significant doctor shortage and causes long waiting lists for primary and specialty care, causing some patients to turn to emergency rooms as a last resort.

“The reliance on emergency care remains stronger than ever,” said Mike Gerardi, president of the ACEP. “It’s the only place that’s open 24/7, and we never turn anyone away.”

Doctor shortages, low Medicaid rates and long waiting lists create perfect storm

A December report by the Health and Human Services Office of the Inspector General showed that more than 50 percent of doctors participating in Medicaid managed-care plans couldn’t accept new Affordable Care Act enrollees. Doctors that were accepting appointments had a median wait time of two weeks, and more than 25 percent of doctors had appointment wait times exceeding one month.

“America has severe primary care physician shortages, and many physicians will not accept Medicaid patients because Medicaid pays so inadequately,” said Gerardi. “Just because people have health insurance does not mean they have access to timely medical care.”

Another complicating factor is that low-income individuals often cannot take time off work during the normal business hours of most primary health care offices. Also, some patients who have lacked health insurance for years have gotten used to depending on the emergency department for their medical needs.

A 2013 report by Truven Health Analytics found that only 29 percent of emergency department patients under the age of 65 actually required immediate medical care. The rest of emergency room patients received care for conditions that did not require immediate attention, could have been provided by a primary care doctor or were avoidable with appropriate preventive care. Another 2013 report by the Robert Wood Johnson Foundation found that the difference in cost between an unneeded emergency room visit and a necessary doctor’s office visit is $580.

Meanwhile, 42 percent of doctors polled by the ACEP fear the problem could become worse if the U.S. Supreme Court chooses to eliminate federal health insurance subsidies when it issues a ruling on “King v. Burwell.” The court is expected to announce its decision in June.

For more information/questions regarding any legal matters, please email or call 310.203.2800.